Incentives for Primary Health Care

1

• Incentives for Primary Health Care
• Team Service Provision
• CIs- Lucio Naccarella, Tony Scott, John Furler,
  Kathryn Dwan
• RFs- Georgia Savage, Fleur Smith, Roz Meredith
• Review Questions
• How are funding, governance and profession
  changes that aim to facilitate teamwork in PHC
  (ie incentives) interpreted and responded to by
  PHC professionals?
• What impact does funding, governance and
  profession incentives thus have on PHC teamwork?
• What are critical ways in which funding,
  governance and profession changes become
  transformed into incentives that have an impact
  on teamwork in primary health care?

2

• Review Approach Update
• Building upon the Models of PHC Review (Steam 6)
• Doing a cross-country narrative review and
  synthesis
• To date 575 documents scanned stored in
  electronic bibliography
• Policy framework/ Intended Outcome/
  Interpretation Response/ Actual outcomes
• Consulted with
• Country Advisory Group Australian PHC key
  informants
• Undertaken Case Study Conceptual Analysis
• Context Mechanism Outcomes

3

• Key Issues I
• Broad macro level context
• Re-orientation to PHC underpinning health system
  reforms
• Increasing burden of chronic, complex
  multi-morbidity
• Concerns about quality, continuity coordination
  of patient care
• Workforce - shortages, mal-distribution skill
  mix role expansion, scope of practice
• Current reform processes context
• Advisory Committees -NHHRC, PHC ERG Nat. Prev.
  Health Taskforce
• Governance, organisational funding reforms
• National Healthcare Partnership agreements
• National Registration / Accreditation
• Federal Primary Care Budget (2009-10)
• Health Workforce Australia clinical placements,
  workforce reforms

4

• Key Issues II
• Anticipated current reform directions
• Regional Primary Health Organisations/Authorities
• Patient registration/enrolment
• Expanded skill mix workforce roles
• Multidisciplinary team-based care / co-location /
  one-stop shops
• Comprehensive PHC Centres GP Superclinics
• Tensions emerging in the review currently
• Definitions conceptualisations of PHC teamwork
• Need to focus on micro, meso macro level
  context mechanisms
• Need to consider
• Concrete dimensions of teamwork
• Conceptual elements underpinning teamwork
• Patient perspectives / experiences of PHC
  teamwork

5

• Early Findings
• Recurring themes
• Consultation processes - aspirational reforms
  limited eval. evidence
• Cross-country commonalities - education, funding,
  organisation of care
• Interprofessional education learning across
  student work life
• Regionalisation of organisation, funding
  delivery of PHC
• Governance arrangements quality control,
  regulation, accountability, risk management
• Focus on macro meso reforms not aligned to
  micro level
• Incentives aligned to purpose (interdep shared
  responsibility)
• Informing Policy Reform directions (CPHC,
  Superclinics) need
• Shared clinical governance (risk and rewards) for
  PHC team work
• Quality evaluation/improvement processes
  involving team patients (quality circles, peer
  review, feedback)
• High level profession engagement support for
  PHC team work
• Practice-level eHealth infrastructure linked to
  governance arrangements
• Reform initiatives aligned to political,
  profession and patient value base

6

• Review Next Steps
• Testing early tentative findings with papers
  reforms (June)
• Review impact of incentive mechanisms on PHC
  teamwork?
• Explore patient perspectives on incentives for
  PHC teamwork?
• Explore governance arrangements that can support
  PHC teamwork?
• Explore how incentive mechanisms differ for PHC
  team working with priority population groups
• Case Study Vic. Community Child Health Teams
  (MPH Student)
• Consultations with
• Country advisory group members
• Australian PHC key informants
• Draft Report
• Policy context Review approach Key findings
  Policy options

7

• The research reported in this presentation is a
  project of the Australian Primary Health Care
  Research Institute, which is supported by a grant
  from the Australian Government Department of
  Health and Ageing.